Active NPI
Shahir Nehad Abdel-Malek
- Periodontics
- St Louis Park, MN
National Provider Identifier
1356684419
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- S84
- Practice address
- 3555 Louisiana Ave S
Saint Louis Park, MN 55426-4121 - Phone
- (202) 280-4401
- NPI assigned
- Mar 27, 2013
- Last updated
- Dec 12, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | S84 | MN | Primary |
Addresses
Primary practice location
3555 Louisiana Ave S
Saint Louis Park, MN 55426-4121
Mailing address
3555 Louisiana Ave S
Saint Louis Park, MN 55426-4121
Phone (202) 280-4401
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jul 13, 2021 through Jul 13, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S84 | MN | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1364342400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1418342400000",
"number": "1356684419",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3555 LOUISIANA AVE S",
"city": "SAINT LOUIS PARK",
"state": "MN",
"postal_code": "554264121",
"telephone_number": "202-280-4401"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3555 LOUISIANA AVE S",
"city": "SAINT LOUIS PARK",
"state": "MN",
"postal_code": "554264121",
"telephone_number": "202-280-4401"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ABDEL-MALEK",
"first_name": "SHAHIR",
"middle_name": "NEHAD",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-03-27",
"last_updated": "2014-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "MN",
"license": "S84",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Louis Park, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.